Effect of Deep Brain Stimulation on Comorbid Self-injurious Behavior: A Systematic Review and Meta-analysis of Individual Patient Data.

OBJECTIVE

Self-injurious behavior (SIB) can occur in the setting of many neurologic disorders that are amenable to deep brain stimulation (DBS). Although certain brain targets are believed to be particularly effective for SIB, improvements in the primary neurologic condition may also reduce co-occurring SIB. We performed a systematic review and meta-analysis of individual participant data to characterize the effects of DBS across various neurologic disorders and brain targets on comorbid SIB.

MATERIALS AND METHODS

A systematic review of all available literature on DBS in treating disorders with co-occurring SIB was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Individual participant data were extracted and standardized mean differences (SMDs) in metrics of SIB severity and/or frequency were calculated for meta-analysis. Demographic variables and adverse events were also collated.

RESULTS

Data from 59 patients, identified from 24 articles, with comorbid SIB who underwent DBS for various indications were extracted. The primary neurologic diagnoses included Tourette syndrome (n = 40), dystonia (n = 7), epilepsy (n = 5), acquired brain injury (n = 3), dyskinesia (n = 2), and obsessive-compulsive disorder (n = 2). Overall, DBS was highly effective in treating comorbid SIB (Mean SMD = -2.4, p < 0.0001) across primary disorders and intracranial targets. Patients with dystonia and DBS targeting the posterior hypothalamus had relatively less success at mitigating comorbid SIB.

CONCLUSIONS

In patients with comorbid SIB, DBS to treat the primary neurologic condition may also mitigate SIB. Although several targets are emerging for the treatment of severe SIB, this work suggests that DBS targeting the primary neurologic condition should be first considered in comorbid SIB.